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Antipsychotic and other types of medications, when used to help people get well, are moderately good things. Before these medications existed, countless mentally ill persons spent a lifetime literally being chained up, and had nothing added to them to hold their horrific disease in check. If not chained up in an asylum, persons with severe mental illness often became the “town idiot” or the “town drunkard.” It isn’t accurate to claim that mental illnesses didn’t exist prior to the invention of the medications. They did exist, and they who suffered from them had a very sorry lot in life.

When doctors accidentally discovered Thorazine, it caused a revolution in the treatment of persons who suffered from psychosis. Prior to the discovery of antipsychotic medications, doctors had only very primitive tools such as electroshock, and lobotomies. In addition to these crude and inhumane methods, doctors also tried insulin shock (injection of a massive amount of insulin in order to temporarily change brain chemistry) and the usage of a small amount of cyanide (also good only for short periods of time.) Doctors would also submerge a patient in a bathtub of ice water as a treatment to calm the person down.

Psychoanalysis was never considered a cure for schizophrenia. The late psychologist Sigmund Freud said he was unable to work with psychotic patients. Psychoanalysis was and is only helpful to those who are fundamentally “normal,” or to people who are made normal through medication. Singer Billy Joel, in one of his 1970’s rock songs said, “You should never argue with a crazy man…” The point I’m making is that you can’t reason your way out of psychosis, and no one can reason with a psychotic person to “cure” them. Changing the brain chemistry is the only way out.

These are all reasons why the discovery of medications to help psychotic people was really a big deal.

Medications do not automatically make someone have “sound reasoning.” What they do is to put the brain in the “ballpark” of proper functioning. Beyond that, if a psychotic episode was of a short duration, a person’s reasoning might return to where it was before the onset of their illness. While medicated, a person with mental illness can often be trained or can train one’s self to have accurate thought processes.

The help that medication provides comes at great cost. I have described in past columns what medication does to a person aside from helping control psychosis, and I won’t repeat myself here. You haven’t and never will hear about someone taking antipsychotic medication other than those who need it. It doesn’t turn you into a happy person and it won’t make your biceps bigger or your abdomen more flat. No one takes these drugs except those who absolutely must.

Medication alone will not make you functional in society. It will not wash the dishes in your sink, and it will not brush your teeth for you. It will not pay your rent. All of these things require the same or more effort than was needed before being medicated. Medication doesn’t insulate a person from the hardships of life, on the contrary. It allows a mentally ill person to face reality; something you, the reader of this manuscript, knows can sometimes be very unpleasant. However, it is much easier to solve a problem when you can acknowledge that the problem exists.

Compliant persons with mental illness often get in the habit of seeking help from their psychiatrist for problems that are not addressable with medication. If a person with schizophrenia occasionally gets depressed or anxious, the psychiatrist must determine if these emotions are within normal limits, or constitute some type of disorder for which another medication is applicable. Medication doesn’t fix the problems in life. However, some of the time it restores normal thought processes which enable the person to attempt to fix those problems. This may require effort as well. And medication doesn’t produce effort, either—you do. Antipsychotic medication, when it works, supports the attempt at normal thought processes. The person with mental illness, through their will and with any additional tools, must accomplish the remainder.